Provider Demographics
NPI:1780740597
Name:WALTER LADA JR DMD LTD
Entity type:Organization
Organization Name:WALTER LADA JR DMD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:LADA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-942-4350
Mailing Address - Street 1:351 BUDLONG RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6001
Mailing Address - Country:US
Mailing Address - Phone:401-942-4350
Mailing Address - Fax:401-942-7190
Practice Address - Street 1:351 BUDLONG RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6001
Practice Address - Country:US
Practice Address - Phone:401-942-4350
Practice Address - Fax:401-942-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI20071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty